Temporomandibular Joint Disorder (TMJD)

What is temporomandibular joint disorder?

Temporomandibular joint disorder (TMJD) is a medical condition characterized by pain in the muscles of the jaw and the temporomandibular joint, the joint of the jaw lying just in front of the ear. Common causes associated with TMJD are excessive contraction of the muscles of the jaw and damage to the temporomandibular joint.

The disease can affected any people of any age group, however, commonly women between the age of 20 and 40 years are at increased risk of suffering from TMJD. There are number of treatment approaches including drugs like pain killers, antidepressants, muscle relaxants, surgical interventions, physical therapy and counseling.

Signs and Symptoms

Common symptoms of TMJD include :

  • Intense pain in the affected jaw. In most of the cases the pain is triggered by chewing and starts as mere discomfort felt during chewing. In severe cases the pain may lead to the muscles of the face.
  • Patient may complain of clicking or popping sound during opening and closure of the jaw even a grating sound may also be heard.
  • Pain in the jaw may radiate to the ear, head even to muscles of the face, neck and shoulder. Ear ache and head ache usually occur in the morning.
  • In severe cases there may be ringing sound in the ear or even diminution of hearing
  • Dizziness, lightheadedness and sudden blackouts.

In many patients the jaw pain may not be the chief complain rather restricted joint movement (lock jaw) may be more severe.

Causes and Risk Factors

Unlike other joints of the body the each TMJ consists of two joints allowing it to rotate and slide. The joint complex includes muscles, nerves, tendons, bones, connective tissue and teeth. The contact surfaces of the bones are protected from wear and tear due to friction by cartilages. The cartilages do not have any pain receptor hence pain originates from the surrounding soft tissue or the adjacent nerve, the trigeminal nerve.
Common causes of TMJD include :

  • Bruxism: in this condition patient unconsciously grinds or clenches the jaw several times during night.
  • Trauma to the joint.
  • Defective tooth like malalignment of the tooth and loss of bite height due to aging.
  • Habit of thrusting the jaw forward during chewing or speaking, nail chewing, eating hard food
  • Degenerative disease of the joint like osteoarthritis and bony ankylosis.
  • Clenching during stress or anger.

More commonly women between 20 and 40 years of age are at increased risk of suffering from TMJD in comparison to men.

Treatment for TMJD

Symptoms of TMJD may disappear without any specific treatment only with pain killers. In more serious cases treatment options include :

  • Drugs like tricyclic anti depressants, muscle relaxants to relieve muscle spasm and sedatives.
  • Non-pharmacological interventions like using oral splints or bite guards, physical therapy including ultrasound, ice and moist heat therapy along with adequate exercise to strengthen the joint.
  • Counseling to change habits of nail chewing, tooth grinding or clenching of jaw.
  • Surgical interventions like arthrocentesis where needle is inserted in the affected joint space to drain fluid, injection of corticosteroid in the joint space and in severe cases replacement of joint may be attempted.

 

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